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Session 4 CM Neur-13
CM- Neuro -13- Spinal Cord Disorders
| Question | Answer |
|---|---|
| What is the most common cause of spinal cord inuries | MVA |
| What information is carried in the corticospinal tract and where does it decusate | carries motor from cerebral cortex decusates in the lower medulla |
| What information is carried in the spinothalamic tract and where does it decusate | Pain and temperature decusated within 1-2 spinal cord segements after entry (IE immediately decusates |
| What information is carried in the posterior column | proprioception and vibration sense |
| If an injury occurs to the spinal column and it affect the corticospinal tract what information will be lost give info as to ipsilateral/contralateral senory/motor | Ipsilateral Motor function (same side of body) as the injury and will affect all areas below the level of the injury |
| If you have a lesion of the spinal cord that destroys the spinothalamic tract what information will be lost (ipsilateral/contralateral and what modalities) | Contralateral pain and temperature from any area below the lesion |
| If you have a lesion of the spinal cord that affect the posterior column what information would be lost (ipsilateral/contralateral and what modality) | Ipsilateral light touch, pressure, joint position and vibration from any area below the lesion |
| What areas (tracts) of the spinal cord are damaged in anterior cord syndrome and what deficits will be seen | damage of the paired anterior spinal arteries or damage by bony fragments causes loss of bilateral spinothalamic tracts and corticospinal tracts this causes complete loss of motor function, pain, temperature, light touch and motion below injury |
| What modalities are preserved in anterior cord syndrome | vibration and position are preserved because the posterior column is still intact |
| What tracts are affected in posterior cord syndrome and what deficits will be seen | rare damage to corticospinal tracts and posterior columns with complete loss of movement and proprioception below the level of the injury (usually neck area) |
| What modalities are spared in posterior cord syndrome | Spinothalamic areas are spared leaving pain and temperature intact below the level of the injury |
| What is Brown Sequard syndrome generally caused by and what deficits will be found in this syndrome | Penetrating Truama that damages all tracts on one side of spinal cord= ipsilater motor, position, vibration loss and Contralateral pain and temperature below level of injury |
| What is the blood supply for the aterior and central spinal cord | Anterior Spinal Artery |
| What is the blood supply for the posterior cord | paired posterior vertebral arteries except for in the cervical cord |
| What area of the spinal cord does the radicular arteries from the aaorta supply | great radicular artery of adamkiewicz can supply 50% of anterior cord in 50% of patients |
| What is the difference between spinal shock and neurogenic shock | spinal shock shows loss of motor and sensory modalities where neurogenic shock is autonomic instability. |
| What are the signs that spinal shock is ending | moves from flaccid paralysis and areflexia to a muscular spasticist, reflex bladder emptying and hyperreflexia |
| What is the ASIA impairment scale | American Spinal Injury Association- A- Complete, B-Incomplete sensory but no motor below level, C- Incomplete Motor function below level < 3, D- Incomplete motor function preserved below level >3 and E Normal |
| In the Asia Scale what does a D mean | Incomplte injury with sparing of Motor function below level of injury with muscle grad > 3 |
| In the asia Scale what does a C mean | Incomplete injury where motor is spared below level of injury with muscle grade < 3 |
| In the asia scale what does a B mean | Incomplete injury where sensory is spared but no motor below the level of the injury |
| in the asia scale what does an A mean | complete spinal injury loss of all motor and sensory below level of injury |
| Pt has just experienced a Hyperflexion of their spine what is the likely syndrome they have developed after causing injury to their spinal cord | Anterior Cervical Cord Syndrome |
| T/F in anterior cord syndrome you typically see sparing of the sacral areas | T |
| What deficits are typically seen in central cord syndrome | central spinothalamic tract, central corticospinal tract and upper extremities greater than lower |
| If you have damage to the conus medullaris what deficits will you see | Saddle anesthesia, sphincter loss, but intact Lower Extermity motor and sensory modalities |
| What deficits will be seen in damage to the cuada equina | Variable sensorimotor deficits and bowel and bladder function losses depending on how much is affected by the injury |
| What are the implications on life expectancy if paraplegia occurs from spinal cord injury | High mortality rate in first year after injury and average life expectancy reduced to 44 years due to pneumonia, PE, heart disease problems |
| If pt has sacral sparing what implications does this have | pt is more likely to have favorable prognosis and regain ambulation |
| If you find hemorrhage in the cord what implications does this have | suggest unfavorable recovery |
| Pts with spinal cord injuries have risk of developing a PE increased 200 times in the first year what can be done prophylactically to reduce risk of PE | Pneumonic compression devices, infractionated heparin, caval filters in pts with high cord lesions |
| Pt has a spinal cord lesion above T6 resulting in autonomic dysfunction what autonomic deficits might they have | low resting blood pressure, bradycardia, orthostatic changes |
| T/F neuropathic spinal pain above the level of the lesion feels like elecrtic shock or temperature discomfort | F it is below the level of the spinal cord lesion |
| T/F neurogenic bladder dysfunction results from reflexes that constantly empty the bladder leading to incontinence | F it is when reflexes may not be sufficient to relax sphincter and bladder get over full might need to be emptied with catheterizations |
| PT has spasticity with their spinal cord injury what benefits may this give and what disadvantages | assists mobility, improves circulation and decreases risk of DVT and osteoporosis but may cause problems with positioning, mobility and spasms may be painful |
| What movement is the most common cause of central cord syndrome | hyperextension of spine |
| Pt presents with weakness in their upper and lower extremities U>L what syndrome is the pt suffering from and likely cuases | Central Cord Syndrome caused by hyperextension of spine, tumor/syringoma |
| Pt was diving into the pool and though it was deeper and crushed their head into the bottom of the pool what spinal cord syndrome are they likely to suffer from if you see a teardrop fracture on x-ray | central cord syndrome |
| Pt has a complete motor paralysis below the level of their injury and and decreased temperature sensation below site. Proprioception is intact and they have sacral sparing what syndrome are they suffering from | anterior cord syndrome caused by flexion/hyperflexion injury |
| Pt has hyperexented their neck and now has loss of proprioception/vibration sense below the level of the injury motor is still intact and pain and temp are only mildly affected what is the pts syndrome | Posterior Cord Syndrome |
| Pt has lost all motor vibration and proprioception in their right side and pain and temperature in their left side below the lesion what syndrome are they suffering from and what is the likely etiologies | brown-sequard syndrome from a penterating trauma, ruptured disc, ischemia, infection, inlammatory disease (TB, MS) or spinal cord tumor |
| If pt has no sensation, flaccid paralysis in both sides and areflexia what syndrome are they suffering from | complete cord syndrome <5% functinal recovery if no improvement in first 24hrs |
| What level does the spinal cord injury have to occur at for the pt to develop quadriplegia | C1-C8 level |
| What level does the spinal cord injury have to occur at for the pt to develop paraplegia | T-1-L-4 |
| Pt cannot breath independently due to a spinal cord injury what level is this injuyr likely at | C1-C3 |
| Pt has a poor cough and can only use diaphragmatic breathing causing hypoventilation what level is their spinal cord lesion likely at | C4 |
| Pt can breath adequately but has a decreased respiratory reserve what level is their spinal cord lesion at | C5-T6 |
| Pt has a spinal cord injury that does not affect respiratory system what level is their spinal cord injury likely at | T6 or T7 -L4 |
| Pt has a spinal cord injury in the C1-T5 region what effect may this have on cardiovascular system | bradycardia, and hypotension (from vasodilation) |
| What effect can a spinal cord injury have on the GI tract | decreases motility leading to paralytic ileus, gastric distention |
| T/F you should avoid antacid administration/PPI use in a pt with a spinal cord injury because it can disrupt the GI functions of the stomach | F you should administer H2 blockers or PPIs in intial stages |
| What do you need to be concerned about in a spinal cord injury pt and the integumentary systems | pressure ulcers and poikilothermism (adjustment of body to room tempreature) from decreased ability to sweat below lesion |
| Should you start your pinprick examination from head down or from toes up | Toes up |
| Why would you order vasopressors like dopamine in spinal cord injury patients | effor to keep mean arterial pressure (2xdiastolic+systolic/3) at 80-90mm/hg to maintain perfusion to cord |
| What drug would you administer to improve blood flow to spinal cord and reduce edema to help in recovery of function after spinal cord injury | Methylprednisolone |
| PT has increased DTR is this more likely an Upper Motor Neuron problem or Lower Motor Neuron | UMN |
| T/F Muscle tone decreases with lower motor neuron injury | T |
| T/F you will see fasciculation with upper motor neurons and not lower motor neuron injuries | F Lower Motor neuron injuries present with fasciculations |
| WHat must you always be ready to provide for a spinal cord injury pt especially if the lesion is higher up (think abc's) | Airway/breathing assistance |
| Why would you want to check spinal cord pts ability to cough | assess their ability to breath on their own |
| What problem can constipation lead to in spinal cord injury pt | autonomic dysreflexia |
| T/F autonomic dysreflexia that can occur from buildup of noxious stimuli such as constipation, urinary retention, pressure/pain is an emergency | T |
| Which of the following present with no reflex changes noted L5/S1, L4/L5, L3/L4 disc prolapse | L4/L5 |
| Which of the following present with absent ankle jerk reflex, pain in posterior thigh and sesnory loss in lateral foot changes noted L5/S1, L4/L5, L3/L4 disc prolapse | L5/S1 disc prolapse |
| Which of the following present with reduced knee jerk reflex, pain in front thigh and sesnory loss in front thigh and medial lower leg L5/S1, L4/L5, or L3/L4 disc prolapse | L3/L4 |
| T/F most metastases to the spinal cord are intradural | F most are extradural |
Created by:
smaxsmith
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